Left Frontal Meningioangiomatosis Associated with Type IIIc Focal Cortical Dysplasia Causing Refractory Epilepsy and Literature Review

Encephalic meningioangiomatosis in a dog with high-grade undefined glioma

Meningioangiomatosis (MA) is a rare proliferative meningovascular disorder that affects mainly the cerebral cortex, brainstem and spinal cord of humans and animals and can coexist with other proliferative disorders. A 7.5-year-old male Brazilian Campeiro Bulldog died after a convulsive crisis and cardiorespiratory arrest. At necropsy, a firm, white mass involving the piriform and right occipital lobes was seen. Histologically, the mass consisted of two morphologically distinct entities that collided: a congenital malformation characterized by a proliferation of meningothelial cells around blood vessels, within the perivascular spaces; and a neoplasm composed of two cell populations with astrocytic and oligodendrocytic differentiation. Meningothelial cells and neoplastic glial cells immunolabelled for vimentin. This first reported case of encephalic MA with a high-grade undefined glioma in a dog was confirmed through clinical signs, pathological and immunohistochemical findings.

Metabolic Changes in Rat Plasma After Epilepsy by UPLC-MS/MS

Introduction:

Epilepsy is one of the most common neurological diseases in clinical practice. The combined application of metabolomics technology plays a great advantage in the screening of biomarkers.

Methods:

In this study, Wistar rats were used as experimental subjects to model intractable epilepsy and to detect the metabolic changes of small molecules in plasma. UPLC-MS/MS was used to determine the small molecules in rat plasma. UPLC HSS C18 (2.1mm×100mm, 1.7 μm) column was used for separation, column temperature of 40°C. The initial mobile phase was acetonitrile -0.3% formic acid with gradient elution, the flow rate was 0.3 mL/min, total running time 4.0 min. Quantitative analysis was performed with multi-response monitoring (MRM).

Results:

Compared to the control group, the L-Alanine and L-Arginine decreased in the Epilepsy group (p<0.05); while Cytosine, Adenosine, L-Tyrosine, Citric acid, Fructose increased (p<0.05).

Conclusion:

In the screening of epilepsy biomarkers using metabolomics, various amino acids that lead to increased energy production and neurotransmitter imbalance play an important role in epileptic seizures.

Meningioangiomatosis: Multimodal Analysis and Insights From a Systematic Review

BACKGROUND

Meningioangiomatosis is a poorly studied, rare, benign, and epileptogenic brain lesion.

OBJECTIVE

To demonstrate that surgical resection and a short-time interval to surgery improves epileptic seizure control, we performed a systematic review and meta-analysis of meningioangiomatosis cases.

METHODS

Using PRISMA-IPD guidelines, the authors performed a systematic review and meta-analysis of histopathologically-proven meningioangiomatosis cases. Literature search in French and English languages (PubMed, Embase, the Cochrane Library, and the Science Citation Index) including all studies (January 1981 to June 2020) dealing with histopathologically-proven meningioangiomatosis, without age restriction. We assessed clinical, imaging, histomolecular, management, and outcome findings of patients with meningioangiomatosis.

RESULTS

Two-hundred and seven cases of meningioangiomatosis from 78 studies were included. Most meningioangiomatosis was sporadic, preferentially concerned male patients, younger than 20 years old, and allowed a functionally independent status. Epileptic seizure was the main symptom, with 81.4% of patients having uncontrolled seizures at the time of surgery. Meningioangiomatosis mainly had frontal (32.3%) or temporal (30.7%) locations. Imaging presentation was heterogeneous, and the diagnosis was often missed preoperatively. The histopathologic pattern was similar whatever the clinical presentation, and immunohistochemistry had limited diagnostic value. On molecular analysis, allelic loss at 22q12 was more frequent in samples of meningioangiomatosis-associated meningioma (37.5%) than in isolated meningioangiomatosis (23.1%). Time interval from diagnosis to surgery (p = 0.011) and lack of surgical resection of the meningioangiomatosis (p = 0.009) were independent predictors of postoperative seizure control.

CONCLUSIONS

Owing to low scientific evidence, a multicentric prospective study should help refining the management of meningioangiomatosis.

Meningioangiomatosis: A review of the variable manifestations and complex pathophysiology

Meningioangiomatosis (MA) is a rare, complex and heterogeneous disease of meningovascular proliferation that is found primarily in the leptomeninges and cerebral cortex but can involve subcortical white matter and other brain regions such as the cerebellum and deep gray matter. MA may be found in pediatric or adult populations and may be sporadic or neurofibromatosis-associated. The presentation of MA is highly variable: it may be associated with other neurological diseases; clinically presents on a spectrum from asymptomatic to seizures or focal deficits; radiologically presents with multifocal, tumor-like, or cystic lesions, or may appear normal; and pathologically may have cellular or vascular predominance. In this article, we review the various manifestations of MA including neurofibromatosis-associated MA, multifocal MA, cystic MA, and MA associated with meningioma, other brain tumors, focal cortical dysplasia, neurodegenerative changes, and post-radiation changes. The treatment of MA is also reviewed. While the pathogenesis of MA remains elusive, we discuss the proposed theories such as developmental, dysplastic, hamartomatous or reactive ethology in given variants. It is important for physicians to be aware of MA as more research on this complex entity is needed and timely diagnosis may benefit outcomes in patients with MA.